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Alimentary Clinical medicine > Malabsorption and Small Intestinal disease > Flashcards

Malabsorption and Small Intestinal disease Flashcards

1
Q

what is the average length of the small intestine?

A

250-450cm

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2
Q

when does the small intestine reach its full length?

A

11 years old

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3
Q

how does the small intestine keep a low bacterial population?

A

presence of bile salts
digestive enzymes
presence of IgA

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4
Q

what are the symptoms of a small bowel pathology?

A 
weight loss
increased appetite
diarrhoea (sometimes steatorrhoea)
bloating
fatigue
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5
Q

what is steatorrhoea?

A 
fat malabsorption
causes stool of high fat content
stool less dense and floats
pale and foul smelling
may leave oily mark or oil droplets
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6
Q

what are the clinical signs of a small bowel pathology?

A 
signs of weight loss
signs of vitamin deficiency's
clubbing
aphthous ulceration
scleroderma
dermatitis herpetiformis
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7
Q

what small bowel condition are these signs most commonly found in;

  1. clubbing?
  2. aphthous ulceration
  3. scleroderma
  4. dermatitis herpetiformis
A
  1. crohn’s and celiac disease
  2. crohn’s and celiac disease
  3. systemic sclerosis
  4. celiac disease
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8
Q

what are the signs of Ca, Mg and vitamin D deficiency?

A

tetany

osteomalacia

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9
Q

what deficiency causes night blindness?

A

vitamin A

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10
Q

what are the signs of deficiency of thiamine and niacin? and from which vitamin group are these in?

A

vitamin B complex
thiamine = memory loss/dementia
niacin = dermatitis, unexplained heart failure

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11
Q

what is a sign of vitamin K deficiency?

A

raised INR/PTR

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12
Q

what tests are carried out for investigating small bowel structure?

A 
small bowel endoscopy and biopsy
small bowel barium meal follow through study
CT scan
MRI enterography
capsule enterography 
white cell scan 
H2 breath test
culture duodenal aspirate
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13
Q

what investigations are carried out to test for bacterial overgrowth?

A

H2 breath test

culture duodenal or jejunal aspirate

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14
Q

what is coeliac disease?

A

sensitivity to gliadin which is found in wheat, rye and barely

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15
Q

in coeliac disease there is an immune response via what enzyme?

A

transglutaminase

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16
Q

what is the pathology of coeliac disease?

A

inflammatory process via transglutaminase
partial or subtotal villus atrophy
increased intraepithelial lymphocytes

17
Q

what tests can be carried out to investigate if its coeliac disease?

A

serology

  • anti endomysial IgA
  • anti-tissue transglutaminase IgA
  • anti-gladin (in children)
distal duodenal biopsy
HLA status (HLA DQ2/DQ8 in coeliac)
18
Q

what is the treatment for coeliac disease?

A

withdrawal gluten from diet

will need referral to a registered dietician for guidance

19
Q

why can a patients HLA status be inaccurate for diagnosing coeliac disease?

A

97% of patients with coeliac disease are HLA DQ2 or DQ8 however so is 30% of the population so could give a false positive

20
Q

why might the seology test anti-tissue transglutaminase be inaccurate in diagnosing coeliac disease, and what can be done to make it more accurate?

A

selective IgA deficiency is not uncommon.
if someone has this then they may falsely show to have coeliac disease when they don’t.
therefore you have to test their IgA before and then the anti-tissue transglutaminase can only be sufficient in people who naturally make IgA

21
Q

what is the clinical presentation of dermatitis herpetiformis and what condition is it commonly found in?

A

coeliac disease

  • blistering
  • itching
  • scalp, knees, elbows, shoulders
  • IgA deposits in the skin
22
Q

what are some of the complications of celiac disease?

A 
refractory small bowel disease
small bowel lymphoma
small bowel adenocarcinoma
oesophageal carcinoma
colon cancer
23
Q

what are causes of malabsorption?

A 
crohns disease
coeliac disease
infection- tropical sprue, HIV, Giardia lamblia 
Whipples disease
Amyloidosis
systemic sclerosis
diabetes
pseudo obstruction
Iatrogenic - gastric surgery, short bowel syndrome, radiation
chronic pancreatitis
cystic fibrosis
24
Q

what makes you more susceptible to Giardia lamblia? and what does this cause?

A

hypogammaglobulinaemia

malabsorption

25
Q

small bowel overgrowth ca occur in any condition which affects what?

A

motility
gut structure
immunity

26
Q

what test is used to diagnose small bowel overgrowth?

A

h2 breath test

27
Q

what is responsible for the large surface area in the small intestine?

A

villi and large turnover of cells in crypts and villi

28
Q

describe the pathology of coeliac disease.

A

inflammatory response via transglutaminase
causes partial / sub total villous atrophy
increased intraepithelial lymphocytes

29
Q

what are some of the conditions that coeliac disease may be associated with?

A 
dermatitis 
diabetes mellitus 
hashimotos 
autoimmune hepatitis 
primary biliary cirrhosis
autoimmune gastritis 
sjogren syndrome 
IgA syndrome
downs syndrome

Alimentary Clinical medicine (23 decks)

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